By Giulio Grecchi, Voice of the Poor Western Region representativeMedicaid expansion is a key component of the Affordable Care Act. One of the central goals of the Affordable Care Act is to significantly reduce the number of uninsured, by providing a continuum of affordable coverage options through Medicaid and the new Health Insurance Exchanges. The expansion of Medicaid would cover most low-income adults up to 138% of the federal poverty level, as of January 1, 2014. Following the June 2012 Supreme Court decision, each State has the independent option to adopt the expansion of Medicaid. Most States in the Western Region have expanded Medicaid, but four States are still opposed or hesitating: Alaska, Idaho, Montana and Utah. Overall, 24 States have either refused the option or are still considering it.The opposition to the expansion is unfortunate, when one considers that:

1 - Millions of low-income people, many of them minimum wage earners, remain without medical coverage, because they:

Earn too much, up to $15,000 a year, to qualify for traditional Medicaid.

Earn too little, to receive subsides through the Health Insurance Marketplace (even though those earning more qualify for financial subsidies that help them pay for health care premiums).

Are too young to qualify for Medicare.

2 - By choosing not to expand access, these states are leaving billions of dollars in available Medicaid federal funds, which would have helped the local economies and created jobs.

It is encouraging to see that in a number of States, where opposition was very strong initially, either the legislature (Maine) or the Governor (Michigan, Ohio) are now trying to make the expansions a reality. This is not always easy to do, because both the legislature and the Governor have to give consent to the expansion and both have to overcome their ideological prejudices. Yet, sometimes, the review process has resulted in a State designing its own creative alternative to the formal Medicaid expansion, like the premium assistance solution in Arkansas, also called “Private Option”, which has received a Section 1115 waiver and is now under implementation, providing affordable medical coverage to all low-income residents earning up to $15,000 a year. Iowa and Pennsylvania have also proposed similar solutions, but they are still under debate.These alternatives have encouraged Utah and other States to examine the Arkansas model and come-up with solutions of their own.

In Idaho, for the last two years, Voice of the Poor Vincentians have worked with Catholic Charities soliciting the expansion of Medicaid. In February, Frank Monasterio, Vincentian from Mountain Home, ID, testified at a hearing of the Joint Finance and Appropriations Committee of the legislature, sharing information supporting the expansion of Medicaid. There is still much opposition in the legislature. They hope for better developments in 2015.